Healthcare Provider Details

I. General information

NPI: 1790771194
Provider Name (Legal Business Name): VETERANS HOME OF CALIFORNIA - CHULA VISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E NAPLES CT
CHULA VISTA CA
91911-6821
US

IV. Provider business mailing address

700 E NAPLES CT
CHULA VISTA CA
91911-6821
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-6010
  • Fax: 619-205-1110
Mailing address:
  • Phone: 619-482-6010
  • Fax: 619-205-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number374601005
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number170000836
License Number StateCA

VIII. Authorized Official

Name: MR. RICHARD M. THOMAS
Title or Position: ACTING ADMINISTRATOR
Credential:
Phone: 619-482-6037